The presence of calcified coronary atherosclerotic plaque (CAP) morphology was found to predict all-cause and cardiovascular mortality among patients with coronary artery disease (CAD) and noncritical stenosis, according to a study published in Angiology.

In this study, 1138 patients (mean age, 58 ± 11 years; 54.3% men; 66.2% with hypertension; 18.8% with diabetes; 34.2% current smokers) with CAD and noncritical stenosis were enrolled. Participants underwent coronary computed tomography angiography (CTA). For CAP categorization, the coronary system was divided into 16 segments, with each one categorized as calcified, noncalcified, or mixed. All-cause and cardiovascular mortality data were collected for prognostic evaluation.

A total of 34.5% of patients had noncalcified CAP, 14.5% had calcified CAP, and 11% had mixed CAP. After a median follow-up of 141.5 months, cardiovascular and all-cause mortality were observed in 57 (5%) and 149 (13.1%) patients, respectively.

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Calcified CAP morphology and the extent of involved segments were found to be significant predictors of cardiovascular and all-cause mortality in a multivariable Cox regression analysis.

Study limitations include the fact that participants were referred for coronary CTA, but that “CAP may be an innocent bystander in patients with chest pain for other reasons,” noted the study authors. In addition, patients with critical stenosis requiring revascularization detected on coronary CTA or conventional coronary angiography were excluded, precluding the establishment of a long-term prognosis of critical stenosis.

“The present study demonstrated that the presence of calcified CAP morphology and a higher number of diseased coronary segments assessed by coronary CTA might help stratify patients at risk for adverse cardiovascular outcomes at long-term follow-up,” the researchers concluded. “Patients with these features at index coronary CTA may be managed more intensely with aggressive preventive measures.”

Disclosures: Some of the study authors reported affiliations with medical device companies. Please see the original reference for a full list of disclosures.


Ates AH, Yorgun H, Canpolat U, et al. Long-term prognostic value of coronary atherosclerotic plaque characteristics assessed by computerized tomographic angiography [published online October 29, 2020]. Angiology. doi: 10.1177/0003319720963677